Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials
Abstract Background Meta-analyses suggest that collaborative care (CC) improves symptoms of depression and anxiety. In CC, a care manager collaborates with a general practitioner (GP) to provide evidence-based care. Most CC research is from the US, focusing on depression. As research results may not...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-020-01299-3 |
| _version_ | 1818246842865942528 |
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| author | Nadja Kehler Curth Ursula Ødum Brinck-Claussen Carsten Hjorthøj Annette Sofie Davidsen John Hagel Mikkelsen Marianne Engelbrecht Lau Merete Lundsteen Claudio Csillag Kaj Sparle Christensen Marie Jakobsen Anders Bo Bojesen Merete Nordentoft Lene Falgaard Eplov |
| author_facet | Nadja Kehler Curth Ursula Ødum Brinck-Claussen Carsten Hjorthøj Annette Sofie Davidsen John Hagel Mikkelsen Marianne Engelbrecht Lau Merete Lundsteen Claudio Csillag Kaj Sparle Christensen Marie Jakobsen Anders Bo Bojesen Merete Nordentoft Lene Falgaard Eplov |
| author_sort | Nadja Kehler Curth |
| collection | DOAJ |
| description | Abstract Background Meta-analyses suggest that collaborative care (CC) improves symptoms of depression and anxiety. In CC, a care manager collaborates with a general practitioner (GP) to provide evidence-based care. Most CC research is from the US, focusing on depression. As research results may not transfer to other settings, we developed and tested a Danish CC-model (the Collabri-model) for depression, panic disorder, generalized anxiety disorder, and social anxiety disorder in general practice. Methods Four cluster-randomized superiority trials evaluated the effects of CC. The overall aim was to explore if CC significantly improved depression and anxiety symptoms compared to treatment-as-usual at 6-months’ follow-up. The Collabri-model was founded on a multi-professional collaboration between a team of mental-health specialists (psychiatrists and care managers) and GPs. In collaboration with GPs, care managers provided treatment according to a structured plan, including regular reassessments and follow-up. Treatment modalities (cognitive behavioral therapy, psychoeducation, and medication) were offered based on stepped care algorithms. Face-to-face meetings between GPs and care managers took place regularly, and a psychiatrist provided supervision. The control group received treatment-as-usual. Primary outcomes were symptoms of depression (BDI-II) and anxiety (BAI) at 6-months’ follow-up. The incremental cost-effectiveness ratio (ICER) was estimated based on 6-months’ follow-up. Results Despite various attempts to improve inclusion rates, the necessary number of participants was not recruited. Seven hundred thirty-one participants were included: 325 in the depression trial and 406 in the anxiety trials. The Collabri-model was implemented, demonstrating good fidelity to core model elements. In favor of CC, we found a statistically significant difference between depression scores at 6-months’ follow-up in the depression trial. The difference was not significant at 15-months’ follow-up. The anxiety trials were pooled for data analysis due to inadequate sample sizes. At 6- and 15-months’ follow-up, there was a difference in anxiety symptoms favoring CC. These differences were not statistically significant. The ICER was 58,280 Euro per QALY. Conclusions At 6 months, a significant difference between groups was found in the depression trial, but not in the pooled anxiety trial. However, these results should be cautiously interpreted as there is a risk of selection bias and lacking statistical power. Trial registration ClinicalTrials.gov, ID: NCT02678624 and NCT02678845 . Retrospectively registered on 7 February 2016. |
| first_indexed | 2024-12-12T14:55:14Z |
| format | Article |
| id | doaj.art-e7a78dbfa96548918a46b91de9243438 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-12T14:55:14Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-e7a78dbfa96548918a46b91de92434382022-12-22T00:20:56ZengBMCBMC Family Practice1471-22962020-11-0121111510.1186/s12875-020-01299-3Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trialsNadja Kehler Curth0Ursula Ødum Brinck-Claussen1Carsten Hjorthøj2Annette Sofie Davidsen3John Hagel Mikkelsen4Marianne Engelbrecht Lau5Merete Lundsteen6Claudio Csillag7Kaj Sparle Christensen8Marie Jakobsen9Anders Bo Bojesen10Merete Nordentoft11Lene Falgaard Eplov12Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Mental Health ServicesCopenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Mental Health ServicesCopenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Mental Health ServicesThe Research Unit for General Practice and Section of General Practice, University of CopenhagenMental Health Center Frederiksberg, Mental Health ServicesStolpegård Psychotherapy Center, Mental Health ServicesGeneral PractitionerMental Health Center North Zealand, Mental Health ServicesDepartment of Public Health, Aarhus UniversityVIVE – The Danish Center for Social Science ResearchVIVE – The Danish Center for Social Science ResearchCopenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Mental Health ServicesCopenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Mental Health ServicesAbstract Background Meta-analyses suggest that collaborative care (CC) improves symptoms of depression and anxiety. In CC, a care manager collaborates with a general practitioner (GP) to provide evidence-based care. Most CC research is from the US, focusing on depression. As research results may not transfer to other settings, we developed and tested a Danish CC-model (the Collabri-model) for depression, panic disorder, generalized anxiety disorder, and social anxiety disorder in general practice. Methods Four cluster-randomized superiority trials evaluated the effects of CC. The overall aim was to explore if CC significantly improved depression and anxiety symptoms compared to treatment-as-usual at 6-months’ follow-up. The Collabri-model was founded on a multi-professional collaboration between a team of mental-health specialists (psychiatrists and care managers) and GPs. In collaboration with GPs, care managers provided treatment according to a structured plan, including regular reassessments and follow-up. Treatment modalities (cognitive behavioral therapy, psychoeducation, and medication) were offered based on stepped care algorithms. Face-to-face meetings between GPs and care managers took place regularly, and a psychiatrist provided supervision. The control group received treatment-as-usual. Primary outcomes were symptoms of depression (BDI-II) and anxiety (BAI) at 6-months’ follow-up. The incremental cost-effectiveness ratio (ICER) was estimated based on 6-months’ follow-up. Results Despite various attempts to improve inclusion rates, the necessary number of participants was not recruited. Seven hundred thirty-one participants were included: 325 in the depression trial and 406 in the anxiety trials. The Collabri-model was implemented, demonstrating good fidelity to core model elements. In favor of CC, we found a statistically significant difference between depression scores at 6-months’ follow-up in the depression trial. The difference was not significant at 15-months’ follow-up. The anxiety trials were pooled for data analysis due to inadequate sample sizes. At 6- and 15-months’ follow-up, there was a difference in anxiety symptoms favoring CC. These differences were not statistically significant. The ICER was 58,280 Euro per QALY. Conclusions At 6 months, a significant difference between groups was found in the depression trial, but not in the pooled anxiety trial. However, these results should be cautiously interpreted as there is a risk of selection bias and lacking statistical power. Trial registration ClinicalTrials.gov, ID: NCT02678624 and NCT02678845 . Retrospectively registered on 7 February 2016.http://link.springer.com/article/10.1186/s12875-020-01299-3Collaborative careAnxiety disordersDepressionGeneral practicePrimary health care |
| spellingShingle | Nadja Kehler Curth Ursula Ødum Brinck-Claussen Carsten Hjorthøj Annette Sofie Davidsen John Hagel Mikkelsen Marianne Engelbrecht Lau Merete Lundsteen Claudio Csillag Kaj Sparle Christensen Marie Jakobsen Anders Bo Bojesen Merete Nordentoft Lene Falgaard Eplov Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials BMC Family Practice Collaborative care Anxiety disorders Depression General practice Primary health care |
| title | Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials |
| title_full | Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials |
| title_fullStr | Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials |
| title_full_unstemmed | Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials |
| title_short | Collaborative care for depression and anxiety disorders: results and lessons learned from the Danish cluster-randomized Collabri trials |
| title_sort | collaborative care for depression and anxiety disorders results and lessons learned from the danish cluster randomized collabri trials |
| topic | Collaborative care Anxiety disorders Depression General practice Primary health care |
| url | http://link.springer.com/article/10.1186/s12875-020-01299-3 |
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